Our Progress in Healthcare
CAREER LADDER IN VERMONT NURSING
CASE FOR SUPPORT
A Skilled Nursing Shortage
The National Nursing Database reports that as of March 2020, Vermont licensed 14,614 RNs and by April of 2021 that number grew by more than 15% to 17,299. Vermont is not part of the interstate nurse licensure compact, therefore nurses must be licensed by examination. However, joining the compact is in discussion in the Vermont legislature as of April 2021. Since Covid, Emergency rules flexibility has been provided by the Legislature to waive exams and fees for Vermont license and re-licensure, to expand the number of nurses who can practice in our state.
Organizing the Healthcare Collaborative
The Vermont Talent Pipeline’s Healthcare Collaborative is comprised of 37 Vermont hospitals, residential care, and home health organizations, which are diverse in size and geography. They initially convened in 2018 to address the shared needs for skilled talent, primarily in the field of nursing. All levels of nurses are in short supply. Traveling nurses are currently hired by even the smallest employers to meet daily care requirements. And with an aging population, we see an exponential demand for nurses with more retirements and more care needed. On the supply side in higher education, programs are turning away up to 50% of their qualified candidates due to limitations of clinical educators and placements.
Participating Healthcare Collaborative employers identified four critical jobs categories representing their greatest need for new and replacement hiring between 2018-20. VTPM forecast a demand for 3900 nurse FTEs, with related credentials, using a needs assessment survey for these critical jobs:
Skilled Nurses (LPNs, RNs)
VTPM produced a report for Vermont’s nurse education providers, relating to the industry’s hiring demands. That report provides both a qualitative and quantitative summary, the competencies required for short-term training in “stackable” high demand skills within education pathways.
On the supply side, Vermont’s Higher Education Nursing programs identified clinical educators as the top barrier to growth. With an estimated $100M in 2021 budgeted for traveling nurses (VAHHS), tapping investments in Education for those most likely to stay and work in Vermont could produce the best return on investment. In August 2018 we learned that Vermont Technical College produces approximately 65% of all licensed skilled nurses in Vermont, and they have the best retention rates for nurses of any Vermont training provider. Not surprisingly VTC licensure candidates are mainly non-traditional students, many who benefit from VTCs 1+1+2 program (LPN, ADN, and BSN) and work while gaining their education.
The barrier to educational expansion was identified as the need for clinical education instruction and placements. Next steps will rely on the healthcare community to provide clinical experiences using trained practicing nurses. Other improvements involve workplace shift supports, hiring efficiencies, career awareness and preparation activities with on-ramps for middle, high school and adult candidates.
In 2018 we forecast a need for 900 skilled nurses in Vermont per year, while in 2019 only 421 completed LPN (128) and RN (293) licensure programs. In an effort to double the number of students licensed in the next several years, we’re planning for larger and more skilled nursing applicant preparation. A series of four prerequisites (available at CCV and Vermont’s Career and Technical Center with dual enrollment options), we’re improving the number and quality of applicants, and those with an additional LNA credential, too.
But there’s more work to be done! Though we’re building a training pipeline with stackable credentials, only a given % of licensed nurses will remain in Vermont without a thoughtful implementation of best employment practices. Employer goals for 2021 include investing in clinical educator training and coordination with Vermont nurse educators. Working together, we will double the number of enrolled applicants who are better prepared to attain licensure and specialty experience, thereby reducing the costs for traveling nurses and the mounting costs associated with turnover.
Stackable nursing credentials provide a low-barrier on-ramp to the nursing profession, that progress with experience and education levels. Additionally, we hope to layer federal apprenticeship funding to assist employers in growing their own people. Studies show a 94% retention rate for four years following apprenticeship completion. Apprenticeships invite all ages to enter a career path with training and pay within the safe, productive, high-paying field of nursing.